go back

Wyoming rates for HCPCS L0455

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf

Facilitymedian $186 · 10th–90th $166–$2090%20%10th90th$186Professionalmedian $166 · 10th–90th $95–$2820%20%10th90th$166$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $134.90 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $275.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $186.21 / $309.03